Presentation
Recurrent uveitis, impaired cognition, and word salad.
Patient Data
Periventricular and infratentorial masses that are uniformly hyperdense with increased surrounding hypoattenuation throughout the cerebral white matter. Coarse calcifications are seen within the infratentorial mass. The masses display avid homogenous enhancement post-contrast. A right frontal ventricular shunt catheter is also noted.
The disease was progressive on CT follow-up.
MRI of the brain demonstrates an infiltrating mass encasing the ventricular system with extension along the ependymal surface. The mass is seen invading and crossing the corpus callosum. There is an additional mass noted in the right cerebellar hemisphere. The masses are slightly hypointense on T2WI with surrounding high signal. There is associated restricted diffusion and avid homogenous enhancement. On SWI, areas of susceptibility in the infratentorial mass were seen probably related to calcifications from treatment-related changes. Additionally seen is a right frontal ventricular shunt catheter.
Case Discussion
This is a classic example of primary CNS lymphoma in an immunocompetent patient. The diagnosis was proven pathologically.
Co Author: Daniel P. Gewolb, MD